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Chaudhary A, Agarwal R. Atypical Presentation of Foster Kennedy Syndrome due to Neurocysticercosis: A Rare Case Report. Rom J Ophthalmol 2024; 68:177-181. [PMID: 39006322 PMCID: PMC11238855 DOI: 10.22336/rjo.2024.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 07/16/2024] Open
Abstract
This case highlights the atypical presentation of Foster-Kennedy syndrome (FKS) associated with Neurocysticercosis (NCC), a prevalent cause of space-occupying lesions in areas endemic to the parasite. We report a newly diagnosed case of NCC in a 13-year-old boy who presented with a one-day history of abnormal movements of the left side of the body and no ocular complaints. Fundus examination of the patient revealed temporal disc pallor and a cup disc ratio (CDR) of 0.6 in the right eye suggesting unilateral optic disc atrophy and a hyperaemic disc with CDR 0.3 and blood vessel tortuosity in the left eye suggesting contralateral impending disc edema, mimicking the classic triad of FKS. He was diagnosed with NCC based on clinical features and radiological findings and was started on Carbamazepine (400 mg), Prednisolone (60 mg), Albendazole (400 mg), Acetazolamide (750 mg), and Vitamin B12 complex. Abbreviations: BCVA = Best Corrected Visual Acuity, CDR = Cup-Disc Ratio, CT = Computed Tomography, FKS = Foster Kennedy Syndrome, IDSA = Infectious Diseases Society of America, ICP = Intracranial Pressure, IOP = Intraocular Pressure, MRI = Magnetic Resonance Imaging, NCC = Neurocysticercosis, OOC = Orbital/Ocular Cysticercosis, OD = Right Eye, OS = Left Eye, OU = Both Eyes, RNFL = Retinal Nerve Fibre Layer, WNL = Within Normal Limits.
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Affiliation(s)
- Aparajita Chaudhary
- Department of Ophthalmology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Ruchi Agarwal
- Department of Ophthalmology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
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Buque H, Vaz D, Lorenzo E, Tané S, Sidat M, Nzwalo H. Severe neurocysticercosis in a quaternary hospital from Mozambique: Case series analysis. Clin Neurol Neurosurg 2023; 233:107913. [PMID: 37544023 DOI: 10.1016/j.clineuro.2023.107913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Neurocysticercosis (NCC) is severe and leading global cause of morbidity and mortality. The disease presents with a variety of clinical presentations from focal to diffuse neurological symptoms. Despite being an endemic country, there are no studies describing the clinico-epidemiological characteristics of NCC in Mozambique. Herein, we describe a consecutive cases series of NCC from the national reference Hospital in Maputo, capital of Mozambique. METHODS Consecutive cases of NCC diagnosed during a 3-year period (January/2020-December/2022) were retrieved from the institutional clinical files and imaging database. RESULTS Six cases of NCC were identified, with mean age of 43.1 years (range 26-66). Four were males (66.6 %). The median time from the beginning of clinical manifestations to the diagnosis was 6 months (range 3-18 months). All patients presented with severe parenchymal NCC, with seizures (n = 5, 83 %) being the most common manifestation. Other clinical manifestations were dementia (n = 1) and hydrocephalus (n = 1). The imaging showed multiple lesions at different stages, with half (n = 3) of them showing the coexistence of nodular calcified lesions at earlier stages (vesicular, colloidal and granular stages). Patients were treated with anthelminthic drugs, corticosteroids and anticonvulsants and no deaths to report. The 3rd month modified Rankin scale was ≤ 2 in 83 % of patients. CONCLUSION In our case series, patients with NCC presented very late, with severe advanced stage disease, with multiple coexistent short and long-term brain lesions. These findings can be explained eventually because of the Maputo Central Hospital being national referral center receiving commonly more severe cases. Studies aiming to clarify the diagnosis pathways/barriers and NCC awareness among medical doctors working at primary and secondary health care level is mandatory to assess the real burden of NCC and implement timely diagnosis and care of patients affected by this neglected disease.
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Affiliation(s)
- Helena Buque
- Neurological Department, Central Hospital of Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Mozambique; Faculty of Medicine and Biomedical Sciences, University of Algarve, Portugal
| | - Deise Vaz
- Neurological Department, Central Hospital of Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Mozambique; Faculty of Medicine and Biomedical Sciences, University of Algarve, Portugal
| | - Elder Lorenzo
- Neurological Department, Central Hospital of Maputo, Mozambique
| | - Suraia Tané
- Radiology Department, Central Hospital of Maputo, Mozambique
| | - Mohsin Sidat
- Faculty of Medicine, Eduardo Mondlane University, Mozambique
| | - Hipólito Nzwalo
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Portugal; Algarve Biomedical Center Research Institute, Portugal.
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Abstract
Neurocysticercosis (NCC) is an important cause of neurological disease worldwide, including imported cases in nonendemic countries. PURPOSE OF REVIEW The purpose of this review is to update information on diagnosis, management, and prevention of neurocysticercosis. RECENT FINDINGS WHO and Infectious Diseases Society of America/American Society of Tropical Medicine and Hygiene guidelines emphasize the importance of corticosteroids and antiparasitic drugs for viable parenchymal disease and single enhancing lesions. Subarachnoid NCC is associated with a high fatality rate unless optimally treated. Advances in subarachnoid NCC include use of prolonged antiparasitic and anti-inflammatory courses and the increasing use of antigen-detection and quantitative PCR assays in diagnosis and follow-up. Emerging data support the safety and efficacy of minimally invasive surgery in ventricular cases. Calcified neurocysticercosis continues to be associated with a high burden of disease. Field studies are demonstrating the feasibility of eradication using a combination of mass chemotherapy for human tapeworms and vaccination/treatment of porcine cysticercosis. SUMMARY NCC remains an important and challenging cause of neurological disease with significant morbidity despite advances in treatment and prevention.
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Veeravigrom M, Thampratankul L. Neurocysticercosis in Children. Pediatr Clin North Am 2022; 69:115-127. [PMID: 34794669 DOI: 10.1016/j.pcl.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neurocysticercosis is one of the most common parasitic infections in the central nervous system in children. The usual clinical manifestation is new-onset focal seizure. However, there are other multiple clinical manifestations, such as increased intracranial pressure, meningoencephalitis, spinal cord syndrome, and blindness. The diagnosis needs high index of suspicion with clinical history, physical examination, neuroimaging, and immunologic studies. Recent advances in neuroimaging and serology facilitate the accurate diagnosis. Management of neurocysticercosis should focus on critical symptoms first, such as the use of antiepileptic drugs and medical or surgical therapy for increased intracranial pressure.
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Affiliation(s)
- Montida Veeravigrom
- Section of Child Neurology, Department of Pediatrics, The University of Chicago Biological Sciences, 5841 South Maryland Avenue, Room C-526, MC 3055, Chicago, IL 60637, USA.
| | - Lunliya Thampratankul
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand
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Espino P, Couper R, Burneo J. An update on Neurocysticercosis-related epilepsy. Clin Neurol Neurosurg 2022; 213:107139. [DOI: 10.1016/j.clineuro.2022.107139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/07/2021] [Accepted: 01/18/2022] [Indexed: 11/03/2022]
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Bustos JA, Arroyo G, Gilman RH, Soto-Becerra P, Gonzales I, Saavedra H, Pretell EJ, Nash TE, O’Neal SE, Del Brutto OH, Gonzalez AE, Garcia HH. Frequency and Determinant Factors for Calcification in Neurocysticercosis. Clin Infect Dis 2021; 73:e2592-e2600. [PMID: 32556276 PMCID: PMC8563199 DOI: 10.1093/cid/ciaa784] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/11/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neurocysticercosis is a major cause of acquired epilepsy. Larval cysts in the human brain eventually resolve and either disappear or leave a calcification that is associated with seizures. In this study, we assessed the proportion of calcification in parenchymal neurocysticercosis and risk factors associated with calcification. METHODS Data for 220 patients with parenchymal NCC from 3 trials of antiparasitic treatment were assessed to determine what proportion of the cysts that resolved 6 months after treatment ended up in a residual calcification at 1 year. Also, we evaluated the risk factors associated with calcification. RESULTS The overall proportion of calcification was 38% (188/497 cysts, from 147 patients). Predictors for calcification at the cyst level were cysts larger than 14 mm (risk ratio [RR], 1.34; 95% confidence interval [CI], 1.02-1.75) and cysts with edema at baseline (RR, 1.39; 95% CI, 1.05-1.85). At the patient level, having had more than 24 months with seizures (RR, 1.25; 95% CI, 1.08-1.46), mild antibody response (RR, 1.14; 95% CI, 1.002-1.27), increased dose albendazole regime (RR, 1.26; 95% CI, 1.14-1.39), lower doses of dexamethasone (RR, 1.36; 95% CI, 1.02-1.81), not receiving early antiparasitic retreatment (RR, 1.45; 95% CI, 1.08-1.93), or complete cure (RR, 1.48; 95% CI, 1.29-1.71) were associated with a increased risk of calcification. CONCLUSIONS Approximately 38% of parenchymal cysts calcify after antiparasitic treatment. Some factors associated with calcification are modifiable and may be considered to decrease or avoid calcification, potentially decreasing the risk for seizure relapses.
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Affiliation(s)
- Javier A Bustos
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Gianfranco Arroyo
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Robert H Gilman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Percy Soto-Becerra
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Isidro Gonzales
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Herbert Saavedra
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - E Javier Pretell
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
- Department of Neurology, Hospital Alberto Sabogal, Callao, Perú
| | - Theodore E Nash
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Seth E O’Neal
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
- School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon, USA
| | - Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo–Ecuador, Samborondón, Ecuador
| | - Armando E Gonzalez
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Hector H Garcia
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
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Bustos J, Gonzales I, Saavedra H, Handali S, Garcia HH. Neurocysticercosis. A frequent cause of seizures, epilepsy, and other neurological morbidity in most of the world. J Neurol Sci 2021; 427:117527. [PMID: 34147957 PMCID: PMC8800347 DOI: 10.1016/j.jns.2021.117527] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 12/07/2022]
Abstract
Neurocysticercosis is endemic in most of the world and in endemic areas it accounts for approximately 30% of cases of epilepsy. Appropriate diagnosis and management of neurocysticercosis requires understanding the diverse presentations of the disease since these will vary in regards to clinical manifestation, sensitivity of diagnostic tests, and most importantly, therapeutic approach. This review attempts to familiarize tropical neurology practitioners with the diverse types of neurocysticercosis and the more appropriate management approaches for each.
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Affiliation(s)
- J Bustos
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - I Gonzales
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - H Saavedra
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - S Handali
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - H H Garcia
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Management of Neurocysticercosis in Children: Association of Child Neurology Consensus Guidelines. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2311-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Carpio A, Romo ML, Hauser WA, Kelvin EA. New understanding about the relationship among neurocysticercosis, seizures, and epilepsy. Seizure 2021; 90:123-129. [DOI: 10.1016/j.seizure.2021.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/26/2021] [Accepted: 02/12/2021] [Indexed: 02/08/2023] Open
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Hamamoto Filho PT, Fragoso G, Sciutto E, Fleury A. Inflammation in neurocysticercosis: clinical relevance and impact on treatment decisions. Expert Rev Anti Infect Ther 2021; 19:1503-1518. [PMID: 33794119 DOI: 10.1080/14787210.2021.1912592] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Neurocysticercosis is caused by the localization of Taenia solium larvae in the central nervous system. The disease remains endemic in most countries of Latin America, Asia and Africa. While major improvements have been made in its diagnosis and treatment, uncertainties persist regarding the clinical implications and treatment of the inflammatory reaction associated with the disease. AREAS COVERED In this review, based on PubMed searches, the authors describe the characteristics of the immune-inflammatory response in patients with neurocysticercosis, its clinical implications and the treatment currently administered. The dual role of inflammation (participating in both, the death of the parasite, and the precipitation of serious complications) is discussed. New therapeutic strategies of potential interest are presented. EXPERT OPINION Inflammatory reaction is the main pathogenic mechanism associated to neurocysticercosis. Its management is mainly based on corticosteroids administration. This strategy had improved prognostic of patients as it allows for the control of most of the inflammatory complications. On the other side, it might be involved in the persistence of parasites in some patients, despite cysticidal treatment, due to its immunosuppressive properties. New strategies are needed to improve therapeutical management, particularly in the severest presentations.
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Affiliation(s)
- Pedro T Hamamoto Filho
- Department of Neurology, Psychology and Psychiatry, UNESP-Univ Estadual Paulista, Botucatu Medical School, Botucatu, Brazil
| | - Gladis Fragoso
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Edda Sciutto
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Agnès Fleury
- Department of Genomic Medicine and Environmental Toxicology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.,Neurocysticercosis Clinic, Instituto Nacional de Neurología Y Neurocirugía, Ciudad de México, Mexico, mexico.,Neuroinflammation Unit, Instituto de Investigaciones Biomédicas-Universidad Nacional Autónoma de México/INNN/Facultad de Medicina-UNAM, Ciudad de México, Mexico
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Lim W, Atere M, Nugent B, Tin S, Khalil A. Neurocysticercosis Presenting With a New-Onset Seizure: A Case Report. Cureus 2021; 13:e13897. [PMID: 33880253 PMCID: PMC8046168 DOI: 10.7759/cureus.13897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 11/25/2022] Open
Abstract
Neurocysticercosis (NCC) is a common infection that is found worldwide but is often neglected in the United States (US). This case report aims to illustrate the presentation of the disease, provide information on this globally prevalent pathogen, and shed light on the diagnostic workup and treatment of the infection. We discuss the case of a 31-year-old male patient of Central American origin presenting with a new-onset seizure. He had no significant past medical history and had never experienced similar events before. The diagnosis was made through neuroimaging, serum antibody testing, and biopsy of the brain lesion. This case highlights the importance of performing a good clinical history and a proper diagnostic workup that would help in the prompt recognization and treatment of this common worldwide illness that may not be endemic to the clinician's geographical area.
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Affiliation(s)
- William Lim
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Muhammed Atere
- Medicine, Richmond University Medical Center, Staten Island, USA
| | - Bryan Nugent
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Swann Tin
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Ambreen Khalil
- Internal Medicine/Infectious Disease, Richmond University Medical Center, Staten Island, USA
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Abraham A, Bustos JA, Carabin H, de Meijere R, Sahu PS, Rajshekhar V, Singh G, White AC, Chiodini PL, Gabriël S, Homeida M, Nash T, Ngowi B, Zhou XN, Coyle C, Garcia HH, Winkler AS. The effectiveness of anti-inflammatory and anti-seizure medication for individuals with single enhancing lesion neurocysticercosis: A meta-analysis and expert group-based consensus recommendations. PLoS Negl Trop Dis 2021; 15:e0009193. [PMID: 33788843 PMCID: PMC8057605 DOI: 10.1371/journal.pntd.0009193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/20/2021] [Accepted: 02/02/2021] [Indexed: 11/18/2022] Open
Abstract
Single brain enhancing lesions (SEL) are the most common presentation of neurocysticercosis (NCC) observed on neuroimaging in people presenting with epileptic seizures not only on the Indian sub-continent and in travelers returning from cysticercosis-endemic regions, but are also present in other parts of the world. The aim of this study, which consisted of a systematic review (CRD42019087665), a meta-analysis and an expert group consultation, was to reach consensus on the best anti-seizure medication and anti-inflammatory treatment for individuals with SEL NCC. Standard literature review methods were used. The Cochrane risk of bias tool was used and random effects model meta-analyses were performed. The quality of the body of evidence was rated using GRADE tables. The expert committee included 12 gender and geographically balanced members and recommendations were reached by applying the GRADE framework for guideline development. The 1-1.5-year cumulative incidence of seizure recurrence, cyst resolution or calcification following anti-seizure medication (ASM) withdrawal was not statistically different between ASM of 6, 12 or 24 months. In contrast, in persons whose cyst calcified post treatment, longer ASM decreased seizure recurrence. The cumulative incidence ratio (CIR) 1-1.5 years after stopping ASM was 1.79 95% CI: (1.00, 3.20) for patients given 6 versus 24 months treatment. Anti-inflammatory treatment with corticosteroids in patients treated with ASM compared to patients treated with ASM only showed a statistically significant beneficial effect on seizure reduction (CIR 0.44, 95% CI 0.23, 0.85) and cyst resolution (CIR 1.37, 95%CI: 1.07, 1.75). Our results indicate that ASM in patients with SEL NCC whose cysts resolved can be withdrawn, while patients whose cysts calcified seem to benefit from prolonged anti-seizure medication. Additional corticosteroid treatment was found to have a beneficial effect both on seizure reduction and cyst resolution.
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Affiliation(s)
- Annette Abraham
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Javier A. Bustos
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru, and Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Hélène Carabin
- Département de Pathologie et de Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Canada
- Département de médecine sociale et préventive, École de santé publique, université de Montréal, Montréal, Canada
- Centre de Recherche en Santé Publique de l’Université de Montréal et du Centre Intégré Universitaire de Santé et des Services Sociaux de sud de l’île de Montréal, Montréal, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Montréal, Canada
| | - Robert de Meijere
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
| | - Priyadarshi S. Sahu
- Department of Microbiology & Immunology, Medical University of the Americas, Nevis, West Indies
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | | | - A. Clinton White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Peter L. Chiodini
- Hospital for Tropical Diseases and the London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Mamoun Homeida
- University of Medical Sciences and Technology, Khartoum, Sudan
| | - Theodore Nash
- Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institute of Health, United States of America
| | - Bernard Ngowi
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania
- University of Dar es Salaam, Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | - Xiao Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
| | - Christina Coyle
- Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Hector H. Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru, and Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Andrea S. Winkler
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Garcia HH, Gonzalez AE, Gilman RH. Taenia solium Cysticercosis and Its Impact in Neurological Disease. Clin Microbiol Rev 2020; 33:e00085-19. [PMID: 32461308 PMCID: PMC7254859 DOI: 10.1128/cmr.00085-19] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Taenia solium neurocysticercosis (NCC) is endemic in most of the world and contributes significantly to the burden of epilepsy and other neurological morbidity. Also present in developed countries because of immigration and travel, NCC is one of few diseases targeted for eradication. This paper reviews all aspects of its life cycle (taeniasis, porcine cysticercosis, human cysticercosis), with a focus on recent advances in its diagnosis, management, and control. Diagnosis of taeniasis is limited by poor availability of immunological or molecular assays. Diagnosis of NCC rests on neuroimaging findings, supported by serological assays. The treatment of NCC should be approached in the context of the particular type of infection (intra- or extraparenchymal; number, location, and stage of lesions) and has evolved toward combined symptomatic and antiparasitic management, with particular attention to modulating inflammation. Research on NCC and particularly the use of recently available genome data and animal models of infection should help to elucidate mechanisms of brain inflammation, damage, and epileptogenesis.
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Affiliation(s)
- Hector H Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Armando E Gonzalez
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Robert H Gilman
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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Zoonotic and vector-borne parasites and epilepsy in low-income and middle-income countries. Nat Rev Neurol 2020; 16:333-345. [PMID: 32427939 DOI: 10.1038/s41582-020-0361-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 12/22/2022]
Abstract
Zoonotic and vector-borne parasites are important preventable risk factors for epilepsy. Three parasitic infections - cerebral malaria, Taenia solium cysticercosis and onchocerciasis - have an established association with epilepsy. Parasitoses are widely prevalent in low-income and middle-income countries, which are home to 80% of the people with epilepsy in the world. Once a parasitic infection has taken hold in the brain, therapeutic measures do not seem to influence the development of epilepsy in the long term. Consequently, strategies to control, eliminate and eradicate parasites represent the most feasible way to reduce the epilepsy burden at present. The elucidation of immune mechanisms underpinning the parasitic infections, some of which are parasite-specific, opens up new therapeutic possibilities. In this Review, we explore the pathophysiological basis of the link between parasitic infections and epilepsy, and we consider preventive and therapeutic approaches to reduce the burden of epilepsy attributable to parasitic disorders. We conclude that a concerted approach involving medical, veterinary, parasitological and ecological experts, backed by robust political support and sustainable funding, is the key to reducing this burden.
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Herrick JA, Bustos JA, Clapham P, Garcia HH, Loeb JA, For The Cysticercosis Working Group In Peru. Unique Characteristics of Epilepsy Development in Neurocysticercosis. Am J Trop Med Hyg 2020; 103:639-645. [PMID: 32431269 PMCID: PMC7410468 DOI: 10.4269/ajtmh.19-0485] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The parasitic helminth infection neurocysticercosis (NCC) is the most common cause of adult-acquired epilepsy in the world. Despite the serious consequences of epilepsy due to this infection, an in-depth review of the distinct characteristics of epilepsy due to neurocysticercosis has never been conducted. In this review, we evaluate the relationship between NCC and epilepsy and the unique characteristics of epilepsy caused by NCC. We also discuss recent advances in our understanding of NCC-related epilepsy, including the importance of anti-inflammatory therapies, the association between NCC and temporal lobe epilepsy, and the recent discovery of biomarkers of severe epilepsy development in individuals with NCC and seizures.
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Affiliation(s)
- Jesica A Herrick
- Division of Infectious Diseases, Immunology, and International Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Javier A Bustos
- Center for Global Health, Instituto Nacional de Ciencias Neurológicas, Universidad Peruana Cayetano Heredia, and Cysticercosis Unit, Lima, Perú
| | - Philip Clapham
- Division of Infectious Diseases, Immunology, and International Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Hector H Garcia
- Center for Global Health, Instituto Nacional de Ciencias Neurológicas, Universidad Peruana Cayetano Heredia, and Cysticercosis Unit, Lima, Perú
| | - Jeffrey A Loeb
- Department of Neurology and Rehabilitation Medicine, University of Illinois at Chicago, Chicago, Illinois
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16
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White AC, Fleury A. Optimal Treatment for Subarachnoid Neurocysticercosis: Closer, but Not There yet. Am J Trop Med Hyg 2020; 102:1-2. [PMID: 31674300 PMCID: PMC6947791 DOI: 10.4269/ajtmh.19-0754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- A Clinton White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Agnes Fleury
- Instituto de Investigaciones Biomédicas-UNAM/Instituto Nacional de Neurología y Neurocirugía/Facultad de Medicina-UNAM, Ciudad de México, Mexico
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17
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Norman FF, Chamorro S, Comeche B, Pérez-Molina JA, López-Vélez R. Update on the major imported helminth infections in travelers and migrants. Future Microbiol 2020; 15:437-444. [PMID: 32250168 DOI: 10.2217/fmb-2019-0273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Helminth infections cause considerable morbidity worldwide and may be frequently underdiagnosed especially in areas of lower endemicity. Patients may harbor latent infections that may become symptomatic years or decades after the initial exposure and timely diagnosis may be critical to prevent complications and improve outcomes. In this context, disease in special populations, such as immunosuppressed patients, may be of particular concern. Heightened awareness and recent diagnostic developments may contribute to the correct management of helminth infections in nonendemic regions. A review of the main helminth infections in travelers and migrants (strongyloidiasis, taeniasis-neurocysticercosis and schistosomiasis) is presented, focusing on epidemiology, developments in diagnosis, treatment and prevention.
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Affiliation(s)
- F F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9100, 28034 Madrid, Spain
| | - S Chamorro
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9100, 28034 Madrid, Spain
| | - B Comeche
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9100, 28034 Madrid, Spain
| | - J A Pérez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9100, 28034 Madrid, Spain
| | - R López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9100, 28034 Madrid, Spain
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18
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Del Brutto OH. A Personal Account Regarding the Origin and Evolution of Controversies in the Management of Neurocysticercosis. Am J Trop Med Hyg 2020; 100:780-782. [PMID: 30761985 DOI: 10.4269/ajtmh.18-0921] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A panel of experts from the Infectious Disease Society of America and The American Society of Tropical Medicine and Hygiene recently published guidelines for management of neurocysticercosis, showing that clinical manifestations as well as the stage of involution and the anatomical location of parasites must be taken into account before the start of a rational therapy. Soon thereafter, isolated opinions attempted to discredit these guidelines, arguing insufficient or inadequate evidence and suggesting that they should not be followed worldwide. In view of these conflicting reports, it is appropriate to review the origin and evolution of the controversy on the medical treatment of neurocysticercosis.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador
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19
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White AC, Coyle CM, Rajshekhar V, Singh G, Hauser WA, Mohanty A, Garcia HH, Nash TE. Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2019; 66:e49-e75. [PMID: 29481580 DOI: 10.1093/cid/cix1084] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/19/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Hector H Garcia
- Instituto Nacional de Ciencias Neurologicas and Universidad Peruana Cayetano Heredia, Lima, Peru
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20
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Hunter E, Cliff M, Armstrong M, Manji H, Jäger HR, Chiodini P, Brown M. Active neurocysticercosis at the Hospital for Tropical Diseases, London: a clinical case series. Trans R Soc Trop Med Hyg 2019; 112:326-334. [PMID: 29982795 DOI: 10.1093/trstmh/try060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/06/2018] [Indexed: 11/12/2022] Open
Abstract
Background Neurocysticercosis is the commonest infectious cause of epilepsy in endemic countries, and accounts for a greater number of cases worldwide than any other single pathology. Infection is associated with long-term exposure in low-income countries, although acquisition after travel has been recognized. The standard of care in the UK is inpatient treatment with anti-helminthic drugs and steroids. Methods The authors reviewed all cases of neurocysticercosis managed at the Hospital for Tropical Diseases in London, England, between 2001 and 2015. Active disease was defined as evidence of either viable cysts or involuting cysts with associated parenchymal inflammation. Results Of 26 active cases, 65.4% were migrants from nine different countries; 34.6% were UK-born travellers who had visited 19 countries across South and Central America, sub-Saharan Africa, South and South-east Asia; India was the commonest country of exposure in both groups. Only 73.1% presented with seizures; two diagnoses were made through brain imaging of patients with peripheral cysticerci; 53.8% had a single cyst. Migrants were more likely to be seropositive than travellers (p=0.033). Only two patients had seizures during admission, one of whom had multiple seizures prior to diagnosis. Conclusions Neurocysticercosis presents in a non-endemic setting in both migrants and travellers. Travellers are less likely to be sero-positive. Not all cases of neurocysticercosis present with seizures. Outpatient management could be considered for selected patients.
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Affiliation(s)
- Ewan Hunter
- Hospital for Tropical Diseases, University College Hospital, London.,London School of Hygiene and Tropical Medicine, London
| | | | | | - Hadi Manji
- Department of Molecular Neuroscience, MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, Queen Square, London
| | - Hans Rolf Jäger
- Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - Peter Chiodini
- Hospital for Tropical Diseases, University College Hospital, London.,London School of Hygiene and Tropical Medicine, London
| | - Mike Brown
- Hospital for Tropical Diseases, University College Hospital, London.,London School of Hygiene and Tropical Medicine, London
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Abstract
PURPOSE OF REVIEW This article discusses select helminthic parasitic infections that may affect the central nervous system and reviews the epidemiology, neurologic presentation, recommended diagnostic testing, and treatment approach to these infections. RECENT FINDINGS Emigration from and travel to areas endemic for helminthic infections that affect the nervous system has led to increased incidence of parasitic neurologic disease in developed countries, necessitating that neurologists be familiar with the diagnostic and therapeutic approach to these diseases. Evidence is emerging on the optimal treatment for neurocysticercosis, which varies based on the form of the disease in the nervous system. SUMMARY Parenchymal neurocysticercosis is a leading cause of acquired epilepsy worldwide, and extraparenchymal neurocysticercosis is responsible for many cases of hydrocephalus. Recognition of the different stages and locations of neurocysticercosis is essential for proper management. Similarly, schistosomiasis constitutes a major cause of myelopathy in endemic areas and requires prompt diagnosis and treatment to avoid permanent deficits.
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Affiliation(s)
- A. Clinton White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
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Abstract
Neurocysticercosis (NCC) occurs following brain infection by larvae of the cestode Taenia solium. It is the leading cause of preventable epilepsy worldwide and therefore constitutes a critical health challenge with significant global relevance. Despite this, much is still unknown about many key pathogenic aspects of the disease, including how cerebral infection with T. solium results in the development of seizures. Over the past century, valuable mechanistic insights have been generated using both clinical studies and animal models. In this review, we critically assess model systems for investigating disease processes in NCC. We explore the respective strengths and weaknesses of each model and summarize how they have contributed to current knowledge of the disease. We call for the continued development of animal models of NCC, with a focus on novel strategies for understanding this debilitating but often neglected disorder.
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25
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White AC, Coyle CM, Rajshekhar V, Singh G, Hauser WA, Mohanty A, Garcia HH, Nash TE. Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Am J Trop Med Hyg 2018; 98:945-966. [PMID: 29644966 PMCID: PMC5928844 DOI: 10.4269/ajtmh.18-88751] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | | | | | | | | | - Aaron Mohanty
- University of Texas Medical Branch, Galveston, Texas
| | - Hector H Garcia
- Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto Nacional de Ciencias Neurologicas, Lima, Peru
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26
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Carpio A, Fleury A, Romo ML, Abraham R. Neurocysticercosis: the good, the bad, and the missing. Expert Rev Neurother 2018. [DOI: 10.1080/14737175.2018.1451328] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Arturo Carpio
- Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca, Ecuador
- G.H. Sergievsky Center, Columbia University, New York, NY, USA
| | - Agnès Fleury
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma, Ciudad de México, México
- Secretaría de Salud, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - Matthew L. Romo
- Department of Epidemiology & Biostatistics and Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Ronaldo Abraham
- Departamento de Medicina, Universidade de Taubaté, São Paulo, Brazil
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Zhang D, Wu J, Wang K, Duan X, Liu S, Zhang B. Which are the best Chinese herbal injections combined with XELOX regimen for gastric cancer?: A PRISMA-compliant network meta-analysis. Medicine (Baltimore) 2018; 97:e0127. [PMID: 29561411 PMCID: PMC5895335 DOI: 10.1097/md.0000000000010127] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The optimal Chinese herbal injections (CHIs) combined with XELOX regimen for patients with gastric cancer remains elusive. The aim of our network meta-analysis (NMA) is to explore the best options among different CHIs for gastric cancer. METHODS PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure Database (CNKI), Wan-fang Database, Cqvip Database (VIP), China Biology Medicine disc (CBMdisc) were searched to identify RCTs which focused on CHIs against gastric cancer. The quality assessment of included randomized controlled trials (RCTs) was conducted by the Cochrane risk of bias tool. Standard pair-wise and Bayesian NMAs were performed to compare the efficacy and safety of different CHIs combined with the XELOX regimen via Stata 13.0 and WinBUGS1.4 software. RESULTS A total of 2316 records were searched, the network of evidence included 26 eligible RCTs involving 13 types of CHIs and 2154 patients. The results suggested that Shenqifuzheng+ XELOX, Huachansu+ XELOX, Kangai+ XELOX, Javanica oil emulsion+ XELOX, Aidi injection+ XELOX might be the optimal treatment for gastric cancer in improving the performance status than using XELOX regimen single, with odds ratios (OR) and 95% confidence intervals (CIs) of 2.74 (1.24, 6.17), 8.27 (1.74, 42.43), 4.28 (1.80, 10.48), 5.14 (1.87, 16.28), 0.20 (0.090, 0.44). At the aspects of ADRs (adverse reactions), Compound Kushen+ XELOX, Lentinan+ XELOX, Xiaoaiping injection+ XELOX could obviously relieve leukopenia than only receiving XELOX regimen, and their ORs and 95% CIs were 5.62 (1.41, 36.24), 8.16 (2.25, 29.43), 5.69 (1.85, 15.77). Furthermore, Disodium cantharidinate and vitamin B6+ XELOX, Shenqifuzheng+ XELOX, Kangai+ XELOX, Lentinan+ XELOX could obviously relieve the nausea and vomiting than receiving the XELOX regimen alone, with ORs and 95% CIs of 5.29 (1.30, 23.96), 2.50 (1.16, 5.26), 2.42 (1.06, 5.63), 9.04 (3.24, 26.73). Nevertheless, CHIs combined with XELOX regimen did not confer higher better clinical effectiveness rate over receiving XELOX regimen alone, with nonstatistically significant between-group differences. CONCLUSIONS As the available evidence suggested that CHIs combined with XELOX regimen could provide treatment benefits for patients with gastric cancer. Among 13 types of CHIs, Javanica oil emulsion and Compound Kushen injection is the optimal treatment in improving the clinical effectiveness rate and performance status, and Lentinan injection was superior in relieving ADRs.
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28
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A novel controlled release microsponges containing Albendazole against Haemonchus contortus in experimentally infected goats. J Drug Deliv Sci Technol 2018. [DOI: 10.1016/j.jddst.2017.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Singh G, Sharma R. Controversies in the treatment of seizures associated with neurocysticercosis. Epilepsy Behav 2017; 76:163-167. [PMID: 28673685 DOI: 10.1016/j.yebeh.2017.05.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/16/2017] [Indexed: 01/08/2023]
Abstract
Seizures are the commonest manifestation of brain parenchymal cysticercosis. In terms of pathophysiological basis and prognostic significance of the seizures, a distinction might be applied between viable cysts, solitary cysticercus granuloma and calcific cysticerci. A number of uncertainties shroud the management of seizures in people with neurocysticercosis (NCC). Although antihelminthic treatment is effective in eliminating viable cysts and possibly cysticercus granulomas, its effect on seizure outcome remains uncertain. Corticosteroids and combinations of antihelminthic and corticosteroid treatments reduce the incidence of seizures in the short term at least. Although antiepileptic drugs (AEDs) are routinely employed in the treatment of seizures associated with NCC, there is no clear consensus regarding the choice and optimal duration of AED treatment. Long-term AED treatment is warranted in people with calcific residue following involution of brain parenchymal cysticercosis. This article is part of a Special Issue entitled "Neurocysticercosis and Epilepsy".
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Affiliation(s)
- Gagandeep Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, India.
| | - Ravina Sharma
- Department of Neurology, Dayanand Medical College, Ludhiana, India
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Wang J, Xu H, Liu P, Li M. Network meta-analysis of success rate and safety in antibiotic treatments of bronchitis. Int J Chron Obstruct Pulmon Dis 2017; 12:2391-2405. [PMID: 28848340 PMCID: PMC5557110 DOI: 10.2147/copd.s139521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to compare the relative efficacy and safety of different antibiotic drugs and recommend superior regimens in the treatment of bronchitis. With respect to the antibiotic comparisons against quinolones in terms of intention-to-treat patients, we concluded that quinolones had advantages over placebo, β-lactams, sulfonamides, and double β-lactams. Concerning treatment methods for clinically evaluable patients, quinolones demonstrated better performance than β-lactams and sulfonamides. The secondary effects of macrolides, quinolones, and double β-lactams were significantly more adverse than β-lactams with odds ratios (ORs) of 1.5 (95% credible interval [CrI] =1.1–2.0), 1.7 (95% CrI =1.2–2.3), and 2.7 (95% CrI =1.8–4.1), respectively. Significant differences in the prevalence of diarrhea as a secondary effect were only identified among the comparisons of double β-lactams against β-lactams and macrolides (OR =5.0, 95% CrI =2.1–12.0; OR =3.0, 95% CrI =1.7–5.4, respectively). Quinolones can be recommended as the superior treatment for bronchitis, in accordance with our cluster analysis with surface under the cumulative ranking curve. The primary outcomes of network meta-analysis indicated that quinolones showed the best performance among the 8 treatments studied, although β-lactams showed the lowest risk of adverse side effects. Quinolones are recommended as the primary treatment option for bronchitis patients, having taking into account the success rates and safety profiles of the eight drugs studied here.
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Affiliation(s)
- Jinghua Wang
- Pediatric of Rheumatology, Immunology and Allergy, The First Hospital of Jilin University, Changchun
| | - Haiyang Xu
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun
| | - Pan Liu
- Department of Oncology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Mingxian Li
- Department of Respiratory, The First Hospital of Jilin University, Changchun, China
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Zammarchi L, Bonati M, Strohmeyer M, Albonico M, Requena-Méndez A, Bisoffi Z, Nicoletti A, García HH, Bartoloni A. Screening, diagnosis and management of human cysticercosis andTaenia soliumtaeniasis: technical recommendations by the COHEMI project study group. Trop Med Int Health 2017; 22:881-894. [DOI: 10.1111/tmi.12887] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Lorenzo Zammarchi
- Unità di Malattie Infettive; Università Degli Studi di Firenze; Florence Italy
- SOD Malattie Infettive e Tropicali; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - Maurizio Bonati
- Department of Public Health, IRCCS; Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
| | - Marianne Strohmeyer
- Unità di Malattie Infettive; Università Degli Studi di Firenze; Florence Italy
| | - Marco Albonico
- Centro per le Malattie Tropicali; Ospedale Classificato Equiparato “Sacro Cuore Don Calabria”; Verona Italy
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health; Universitat de Barcelona; Barcelona Spain
| | - Zeno Bisoffi
- Centro per le Malattie Tropicali; Ospedale Classificato Equiparato “Sacro Cuore Don Calabria”; Verona Italy
| | | | - Hector H. García
- Cysticercosis Unit; Universidad Peruana Cayetano Heredia; Lima Peru
| | - Alessandro Bartoloni
- Unità di Malattie Infettive; Università Degli Studi di Firenze; Florence Italy
- SOD Malattie Infettive e Tropicali; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
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Kumar A, Mandal A, Sinha S, Singh A, Das RR. Prevalence, Response to Cysticidal Therapy, and Risk Factors for Persistent Seizure in Indian Children with Neurocysticercosis. Int J Pediatr 2017; 2017:8983958. [PMID: 28167968 PMCID: PMC5259654 DOI: 10.1155/2017/8983958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/02/2016] [Accepted: 12/18/2016] [Indexed: 01/01/2023] Open
Abstract
Background. Neurocysticercosis (NCC) is the commonest cause of childhood acquired epilepsy in developing countries. The use of cysticidal therapy in NCC, except "single lesion NCC," is still debated in view of its doubtful usefulness and potential adverse effects. Methods. Children presenting with first episode of seizure or acute focal neurological deficit without fever were screened for NCC and received appropriate therapy (followup done for 1 year to look for the response and side effects). Results. The prevalence of NCC was 4.5%. Most common presenting feature was generalized seizure and commonest imaging finding was single small enhancing lesion in the parietal lobe. Abnormal EEG and CSF abnormalities were found in almost half of the children. The response to therapy was very good with infrequent recurrence of seizure and adverse effects of therapy were encountered rarely. No risk factors for persistent seizure could be identified. Conclusion. Present study shows that the response to cysticidal therapy is very good in NCC as seizure recurrence was observed in only 5%, 4.2%, and 4.2% of cases at 3-month, 6-month, and 1-year followup. Adverse effects of therapy were observed in 20% of cases during therapy but they were mild and self-limiting.
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Affiliation(s)
- Animesh Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anirban Mandal
- Department of Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi 110016, India
| | - Sheela Sinha
- Department of Pediatrics, Patna Medical College and Hospital, Patna 800004, India
| | - Amitabh Singh
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi 110031, India
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar 751019, India
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Abstract
Neurocysticercosis is an important cause of seizures worldwide and is endemic in most of Latin America, Sub-Saharan Africa, Southeast Asia, India, and China. Neurocysticercosis has profoundly different disease manifestations varying from asymptomatic presentation to life-threatening hydrocephalus. Clinical manifestations, pathogenesis, diagnostic methods, and optimal treatment vary with the location, number of lesions, and host response. Diagnosis is based on a combination of clinical presentation, neuroimaging findings, history of exposure, and serologic testing. Initial therapy should be focused on symptom management including seizure control and management of increased intracranial pressure. Emerging data are demonstrating that the optimal management approach varies with stage. Single enhancing or cystic lesions should be treated with albendazole and steroids. Patients with more than two cystic lesions should be treated with combination therapy with albendazole and praziquantel, whereas patients with hydrocephalus benefit from surgical management, especially with minimally invasive approaches.
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Affiliation(s)
- Camille M Webb
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, 301 University Boulevard, Rt 0435, Galveston, TX, 77555-0435, USA
| | - A Clinton White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, 301 University Boulevard, Rt 0435, Galveston, TX, 77555-0435, USA.
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Mahajan L, Malhotra HS, Garg RK, Kumar N, Sharma PK, Verma R, Rizvi I. Predictors of Lesion Calcification in Patients with Solitary Cysticercus Granuloma and New-Onset Seizures. Am J Trop Med Hyg 2016; 95:623-8. [PMID: 27430545 DOI: 10.4269/ajtmh.16-0070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 06/14/2016] [Indexed: 11/07/2022] Open
Abstract
Solitary cysticercus granuloma is a common neuroimaging abnormality in Indian patients with new-onset epilepsy. Calcific transformation of cysticercus granuloma is frequently associated with seizure recurrence. We evaluated predictors of lesion calcification in patients with solitary cysticercus granuloma and new-onset seizures. One hundred twenty-two patients, with new-onset seizures and a solitary cysticercus granuloma of the brain, were enrolled. All patients were clinically and radiologically evaluated and were treated with antiepileptic drug drugs. No patient received albendazole or corticosteroids. The follow-up period was of 1 year. Follow-up computed tomography was performed after 3 and 6 months. In 68 (54.8%) patients, solitary cysticercus granuloma had transformed into a calcified lesion. On logistic regression analysis, moderate-to-severe edema was a significant factor that predicted calcific transformation of the cysticercus granuloma (odds ratio: 3.325; 95% confidence interval: 1.502-7.362). During 1 year of follow-up, 19 (15.6%) patients experienced seizure recurrence. In 16 patients with seizure recurrence, cysticercus granuloma had transformed in to a calcified lesion. In conclusion, in solitary cysticercus granuloma, calcification of the lesion can be predicted if larger amount of perilesional edema is present. Calcification of the granuloma significantly predicts seizure recurrence.
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Affiliation(s)
- Lalit Mahajan
- Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow, India
| | | | - Ravindra Kumar Garg
- Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow, India.
| | - Neeraj Kumar
- Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow, India
| | - Praveen Kumar Sharma
- Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow, India
| | - Rajesh Verma
- Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow, India
| | - Imran Rizvi
- Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow, India
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